早产儿加温湿化高流量经鼻导管通气初始呼吸支持失败的危险因素分析

目的 分析早产儿加温湿化高流量鼻导管通气（heated humidified high-flow nasal cannula,HHHFNC）初始呼吸支持失败的危险因素。 方法 回顾性收集2018年1月至2021年4月收治的生后使用HHHFNC初始呼吸支持的早产儿病例资料,根据治疗后72 h内是否需升级为无创持续气道正压通气或有创机械通气,分为呼吸支持失败组和成功组,采用单因素分析与多因素logistic回归分析HHHFNC呼吸支持失败的危险因素。 结果 共纳入166例早产儿,HHHFNC呼吸支持失败48例（28.9%）。单因素分析结果显示：呼吸支持失败组胎龄、出生体重均低于成功组（n=118）,吸入氧浓度>35%、流量>6 L/min、发生动脉导管未闭（patent ductus arteriosus,PDA）、诊断新生儿呼吸窘迫综合征（respiratory distress syndrome,RDS）、使用肺表面活性物质治疗比例均高于成功组（P<0.05）。多因素logistic回归分析显示：胎龄<32周、PDA >1.5 mm且左心房∶主动脉内径>1.4、吸入氧浓度>35%、流量>6 L/min、RDS是HHHFNC初始呼吸支持失败的危险因素（P<0.05）。 结论 当早产儿胎龄<32周,或有RDS时,早产儿HHHFNC初始呼吸支持失败的风险高;在HHHFNC初始呼吸支持治疗中,当氧浓度>35%和/或流量>6 L/min,或出现PDA时,呼吸支持失败的风险增大,应积极考虑升级呼吸支持方式。 引用格式:     

有血流动力学意义的动脉导管未闭早产儿布洛芬治疗失败的危险因素分析

目的 研究有血流动力学意义的动脉导管未闭（hemodynamically significant patent ductus arteriosus, hsPDA）早产儿布洛芬治疗失败的高危因素。方法 回顾性收集华中科技大学同济医学院附属湖北妇幼保健院新生儿科2018年1月—2023年6月收治的胎龄<34周hsPDA早产儿的临床资料,根据治疗方式的不同分为布洛芬组（95例）和布洛芬+手术组（44例）,采用二元logistic回归分析探讨hsPDA早产儿布洛芬治疗失败的高危因素。结果 二元logistic回归分析显示,动脉导管直径增大、大脑中动脉阻力指数（resistance index, RI）值≥0.80、总有创机械通气时间延长是hsPDA早产儿布洛芬治疗失败的高危因素（P<0.05）。受试者操作特征曲线分析显示,动脉导管直径>2.85 mm,大脑中动脉RI值≥0.80,总有创机械通气时间>16 d对hsPDA早产儿布洛芬治疗失败具有预测价值（P<0.05）;三者联合预测价值最高,曲线下面积为0.843,灵敏度为86.5%,特异度75.0%(P<0....     

晚期早产儿脐血维生素D水平及维生素D3补充对婴幼儿行为发育的前瞻性随机对照研究（英文翻译）

目的 探讨晚期早产儿25-羟维生素D［25-hydroxyvitamin D,25(OH)D］水平及维生素D₃补充对婴幼儿神经行为发育的影响。 方法 前瞻性选取2017年6月—2020年6月收治的晚期早产儿161例为研究对象,根据脐血25(OH)D水平分为充足组（52例）、不足组（53例）、缺乏组（56例）,每组按随机数字法分为A亚组（维生素D₃ 800 IU/d）、B亚组（个体化补充维生素D₃）。分析比较各组生后3个月25(OH)D水平、纠正胎龄10个月及纠正胎龄18个月25(OH)D水平及Gesell发育量表评分的差异。 结果 生后24 h内及3个月时,不足组、缺乏组25(OH)D水平低于充足组（P<0.05）,不足组25(OH)D水平高于缺乏组（P<0.05）;缺乏组生后3个月时B亚组25(OH)D水平高于A亚组（P<0.05）。不足组和缺乏组纠正胎龄10个月、纠正胎龄18个月时Gesell发育量表5个能区得分均低于充足组（P<0.05）;缺乏组纠正胎龄10个月时言语能、纠正胎龄18个月时粗大动作能得分低于不足组（P<0.05）。缺乏组B亚组纠正胎龄10个月时适应能、纠正胎龄18个月时适应能和应物能得分高于A亚组（P<0.05）。 结论 晚期早产儿脐血25(OH)D水平存在明显差异,个体化补充维生素D方案对于纠正维生素D缺乏更为有效。出生时及婴儿早期维生素D水平对神经行为发育有一定影响。     

肠道局部组织氧饱和度和C-反应蛋白在诊断早产儿坏死性小肠结肠炎中的价值

目的 探讨肠道局部组织氧饱和度(regional oxygen saturation,rSO₂)和C-反应蛋白(C-reactive protein,CRP)在早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)诊断中的临床价值。方法 采用前瞻性观察性方法,选取2020年10月—2021年12月安徽医科大学附属省儿童医院住院的早产儿为研究对象,其中NEC组22例,非NEC组35例。NEC组在NEC确诊后24 h内监测肠道r SO₂,并于抗感染治疗前检测血清CRP水平;非NEC组对应时间点进行肠道rSO₂监测和血清CRP检测。比较2组肠道rSO₂和血清CRP水平的差异,并采用受试者工作特征曲线分析肠道rSO₂、血清CRP单独及二者联合诊断早产儿NEC的价值。结果 NEC组的肠道rSO₂低于非NEC组(P<0.05),血清CRP水平高于非NEC组(P<0.05)。受试者工作特征曲线分析显示：肠道rSO₂     

早产儿动脉导管未闭手术治疗新进展

早产儿动脉导管未闭(patent ductus arteriosus,PDA)的发病率较高,特别是在出生胎龄<28周的超早产儿(extremely preterm infant,EPI)中.血流动力学异常的PDA如持续存在,不仅可引起一系列并发症,还是早产儿死亡率升高的重要危险因素.关于早产儿PDA的管理一直是新生儿医...     

新生儿动脉导管未闭的微创手术治疗及管理

动脉导管未闭(patent ductus arteriosus,PDA)是新生儿较常见的先天性心脏病,其发病率约为0.5%,而早产儿PDA的发病率高达40%~60%。导管粗大的患儿常于新生儿期出现呼吸急促或呼吸困难等症状,部分可引起肺动脉高压、心力衰竭、呼吸衰竭,     

1 732例儿童血清维生素K2临床分析及其与骨代谢标志物关系的研究

目的 分析儿童血清维生素K₂（vitamin K₂,VitK₂）临床特征及其与骨钙素（osteocalcin,OC）、Ⅰ型前胶原氨基端前肽（type Ⅰ procollagen amino-terminal peptide,PINP）、Ⅰ型胶原交联羧基末端肽（type Ⅰ collagen carboxy-terminal peptide,CTX）的相关性。 方法 前瞻性选取2020年10月至2021年10月门诊常规体检儿童1 732例,测定血清VitK₂、25羟维生素D［25-hydroxyvitamin D,25(OH)D］水平,按年龄段分为<1岁组、1~3岁组、>3~6岁组、>6~14岁组,进行血清VitK₂相关临床分析。筛选出25(OH)D≥50 nmol/L的儿童共309例,测定血清OC、PINP、CTX水平,分析不同年龄段水平及其与血清VitK₂的相关性。 结果 血清VitK₂缺乏率为52.31%（906/1 732）。VitK₂缺乏组超重/肥胖、生长痛（≥3岁）发生率均高于VitK₂正常组（P<0.05）;1~3岁组和>6~14岁组血清VitK₂缺乏率（P<0.0083）、血清VitK₂水平（P<0.05）差异有统计学意义。<1岁组儿童血清CTX水平高于>3~6岁组和>6~14岁组,而<1岁组儿童血清PINP水平低于>3~6岁组和>6~14岁组（P<0.05）;<1岁组血清OC水平低于>6~14岁组（P<0.05）。血清VitK₂与OC呈正相关（r_s=0.347,P<0.01）,CTX与PINP呈负相关（r_s=-0.317,P<0.01）。 结论 VitK₂缺乏可能与超重/肥胖有关;血清VitK₂可影响OC水平进而影响骨骼健康。     

妊娠期高血压疾病对胎龄28~34周早产儿外周静脉血细胞计数的影响

目的 探讨母亲妊娠期高血压疾病（hypertensive disorders of pregnancy,HDP）对胎龄28~34周早产儿外周静脉血细胞计数的影响。 方法 选取2020年1~12月昆明医科大学第一附属医院儿科收治的母亲合并HDP的胎龄28~34周早产儿227例为研究组,另选取同期收治的母亲无HDP的胎龄28~34周早产儿227例为对照组。研究组根据母亲妊娠期血压分为妊娠期高血压亚组（75例）、轻度子痫前期亚组（81例）、重度子痫前期亚组（71例）;根据早产儿出生体重分为小于胎龄儿（small for gestational age,SGA）亚组（113例）及适于胎龄儿（appropriate for gestational age,AGA）亚组（114例）。比较研究组和对照组、研究组各亚组间早产儿生后第1天外周血细胞计数的差异。 结果 研究组患儿生后第1天外周静脉血白细胞（white blood cell,WBC）计数、中性粒细胞绝对计数（absolute neutrophil count,ANC）及血小板（platelet,PLT）计数均低于对照组（P<0.05）,白细胞减少症、中性粒细胞减少症发生率高于对照组（P<0.05）。亚组分析中,轻度子痫前期亚组、重度子痫前期亚组WBC计数、ANC、PLT计数均低于妊娠期高血压亚组（P<0.05）;SGA亚组WBC计数、ANC、PLT计数低于AGA亚组（P<0.05）。 结论 HDP可对早产儿外周静脉血细胞计数产生影响,这一影响在母亲子痫前期及SGA早产儿中更为显著。     

早产儿动脉导管未闭的发病机制、高危因素及并发症

早产儿持续性动脉导管未闭(patent ductus arteriosus,PDA)可引起严重的临床后果,特别是体重小于1000g的超低出生体重儿,在新生儿呼吸窘迫综合征(RDS)恢复期间,随着肺通气和氧合的提高、肺血管阻力下降,体循环阻力增大,使流经动脉     

超早产儿生后72 h内低血压发生的危险因素及预后分析

目的 探讨超早产儿生后72 h内低血压的危险因素和预后。方法 回顾性分析2019年1月—2022年4月于浙江大学医学院附属儿童医院收治的超早产儿住院期间的临床资料。根据生后72 h内是否存在低血压，将入选患儿分为低血压组（41例）和正常血压组（82例），比较2组的临床特征、出生后72 h内的超声心动图参数和早期并发症，并采用多因素logistic回归分析探讨生后72 h内低血压的危险因素。采用受试者操作特征曲线分析评估相关指标预测超早产儿生后72 h内发生低血压的价值。结果 低血压组7 d内药物或手术关闭动脉导管未闭（patent ductus arteriosus, PDA）、≥Ⅲ度脑室内出血和严重肺出血的患儿比例及7 d内病死率显著高于正常血压组（P<0.05）。多因素logistic回归分析显示，出生体重较低、PDA直径较大及有血流动力学意义的PDA是超早产儿生后72 h内发生低血压的危险因素（P<0.05）。受试者操作特征曲线分析显示，出生体重、PDA直径、有血流动力学意义的PDA 3个指标联合预测超早产儿生后72 h内发生低血压的曲线下面积为0.873 (95%C...     

Cardiocirculatory effects of patent ductus arteriosus in extremely low-birth-weight infants with respiratory distress syndrome

BACKGROUND: Cardiocirculatory effects of hemodynamically significant patent ductus arteriosus (hsPDA) have not been systematically studied in extremely low-birth-weight (ELBW) infants with respiratory distress syndrome (RDS). The objective of the present study was to evaluate the effects of hsPDA on the left ventricular output (LVO) and organ blood flows in ELBW infants with RDS. METHODS: Extremely low-birth-weight infants (birth-weight <1000 g) treated with surfactant for RDS were studied by serial Doppler flow examinations. Doppler flow variables in 19 infants in whom hsPDA developed (hsPDA group) were compared with those in 19 infants without hsPDA matched for gestational age, birth-weight, and postnatal age (non-hsPDA group). All infants in the hsPDA group had pharmacologic closure of ductus arteriosus when hsPDA developed. RESULTS: Before pharmacological closure of PDA, the hsPDA group had significantly higher LVO, lower blood flow volume of the abdominal aorta, and lower mean blood flow velocities in the celiac artery, superior mesenteric artery, and renal artery than the non-hsPDA group. These alterations in the hsPDA group reverted to the levels in the non-hsPDA group after the closure of PDA and had no deleterious effects on the cardiorespiratory status. No significant differences between the groups were found in mean blood flow velocities of the anterior cerebral artery throughout the study period. CONCLUSION: These results indicate that although LVO is increased, the splanchnic and renal blood flows are decreased when hsPDA develops in ELBW infants with RDS. The effects of these alterations of LVO and organ blood flows on the cardiorespiratory course seem to be minor when early pharmacologic closure of PDA is done.     

生后早期床旁心脏超声预测极低出生体重儿动脉导管持续开放的研究(英文翻译)

目的 探讨出生早期床旁心脏超声预测极低出生体重儿（very low birth weight infant,VLBWI）动脉导管持续开放的价值。 方法 回顾性选取2020年3月至2021年6月收治的51例VLBWI为研究对象,入院时日龄≤3 d并且住院时间≥14 d。根据出生14 d及28 d动脉导管未闭（patent ductus arteriosus,PDA）直径大小分为3组：大PDA组（PDA直径≥2 mm）、小PDA组（PDA直径<2 mm）和PDA关闭组（PDA直径=0 mm）,比较3组间生后72 h的心脏超声参数。采用受试者工作特征（receiver operating characteristic,ROC）曲线评估生后72 h心脏超声参数预测生后14 d和28 d动脉导管持续开放（PDA直径≥2 mm）的价值。 结果 生后14 d时,大PDA组有17例,小PDA组11例,PDA关闭组23例;生后28 d时,大PDA组有14例,小PDA组9例,PDA关闭组26例。3组患儿间胎龄、出生体重、肺泡表面活性物质应用及低血压发生率的比较差异有统计学意义（P<0.05）。生后72 h的PDA直径、左肺动脉舒张末期流速、左心室输出量、左心室输出量/上腔静脉血流与生后14 d及28 d时动脉导管持续开放有关（P<0.05）;左心房/主动脉根部直径与生后28 d时动脉导管持续开放有关（P<0.05）。ROC曲线结果显示,生后72 h PDA直径预测生后14 d及28 d动脉导管持续开放的曲线下面积最大,分别为0.841和0.927;其次是左肺动脉舒张末期流速,其曲线下面积分别为0.793和0.833。 结论 生后72 h的床旁心脏超声指标,尤其是PDA直径及左肺动脉舒张末期流速,可预测VLBWI生后14 d和28 d动脉导管持续开放,为后续PDA早期目标性治疗策略的实施提供依据。     

极低出生体重儿动脉导管未闭转归的影响因素分析

目的分析极低出生体重儿动脉导管未闭(PDA)转归的影响因素。方法以2012年1月至2014年12月收治的194例极低出生体重儿为研究对象,根据心脏超声检查及治疗转归情况分为无PDA组,PDA自然关闭组、药物关闭组、手术关闭组,分析其临床及超声心动图特征。结果 PDA自然关闭率58.7%。自然关闭组的出生胎龄、出生体重、小于胎龄儿比例均大于药物和手术关闭组,药物及手术关闭组的新生儿呼吸窘迫综合征发生率及肺表面活性物质(PS)应用比例高于自然关闭组(P0.05)。不同时间段自然关闭组的动脉导管直径均明显小于药物和手术关闭组(P0.05)。多因素logistic回归分析示出生胎龄、PS应用及48 h动脉导管直径与PDA转归显著相关。自然关闭组PDA分流类型均以关闭型为主,而药物及手术关闭组在48 h以肺高压型及进展型为主,在4 d、7 d时均以进展型为主。结论极低出生体重儿PDA自然关闭率较高,出生胎龄越小以及应用PS的患儿自然关闭率越低;动脉导管直径越大且分流类型为进展型或脉冲型的PDA不易自然关闭。     

Cerebral and Abdominal Arterial Hemodynamics in Preterm Infants with Patent Ductus Arteriosus

Using Doppler echocardiography we evaluated the effect of ductal shunt flow on the cerebral and abdominal arterial blood flow in 25 preterm infants. Eligible for inclusion in this study were healthy preterm newborn infants. They were divided into two groups based on their gestational age: group A, 33-36 weeks (15 infants) and group B, 28–32 weeks (10 infants). Two-dimensional Doppler echocardiograms were obtained in each infant during the first 8 hours of life and repeated every 6–12 hours until no ductal shunt flow could be detected. Flow in the ductus arteriosus, the basilar artery and the coeliac artery were examined. Closure of the ductus arteriosus occurred significantly later(p< 0.05) in group B than in group A. Pulsatility indices of flow in the basilar and coeliac arteries were high when the ductus was patent, decreasing to a fixed level with closure. This study suggests that a shunt of the patent ductus arteriosus (PDA) adversely influences the cerebral and abdominal blood flow in preterm infants.     

血小板聚集功能预测早产儿动脉导管持续开放的价值

目的探讨血小板聚集功能预测早产儿动脉导管持续开放的价值。方法前瞻性选择徐州中心医院新生儿重症监护病房2017年8月至2019年10月收治的出生胎龄<32周早产儿72例进行巢氏病例对照研究。生后第4~5天完成超声心动图检查,将符合有血流动力学意义的动脉导管未闭(hsPDA)诊断标准的早产儿纳入hsPDA组,按照1∶2匹配非hsPDA早产儿作为对照组。记录早产儿基本特征,检测血常规和血小板聚集功能。选用独立样本t检验和χ2检验进行数据的组间比较,二元Logistic回归分析和受试者工作特征曲线分析危险因素和预测价值。结果最终纳入hsPDA组24例(男16例),匹配对照组48例(男30例)。hsPDA组≥Ⅱ级新生儿呼吸窘迫综合征的比例高于对照组[67%(16/24)比27%(13/48),χ²=10.422,P=0.001]。hsPDA组血小板压积和二磷酸腺苷诱导血小板聚集率均低于对照组(0.0021±0.0009比0.0028±0.0009、0.21±0.10比0.32±0.07,t=-3.043、-5.093,P=0.004、<0.01),血小板平均体积大于对照组[(10.3±2.4)比(9.2±2.0)fl,t=2.713,P=0.033]。其他血小板参数(血小板计数、血小板分布宽度和大血小板比率)及诱导剂(胶原、肾上腺素和花生四烯酸)诱导血小板聚集率两组差异均无统计学意义(均P>0.05)。二磷酸腺苷诱导血小板聚集率低和血小板压积低是早产儿发生hsPDA的独立危险因素(OR=4.525、3.994,95%CI:1.305~15.689、1.143~13.958)。二磷酸腺苷诱导血小板聚集率具有预测早产儿发生hsPDA的中等价值(受试者工作特征曲线下面积为0.809,最佳预测界值为0.245,敏感度为0.67,特异度为0.86)。结论血小板聚集功能差和血小板压积低是出生胎龄<32周早产儿发生hsPDA的独立危险因素。血小板聚集功能预测早产儿动脉导管持续开放的价值中等。     

The fate of ductus arteriosus in infants at 23-27 weeks of gestation: from spontaneous closure to ibuprofen resistance

BACKGROUND: Some extremely preterm infants experience spontaneous closure of the ductus arteriosus. On the other side, a high percentage (22-30%) of preterm infants born at the lower gestational age fail to respond to a single course of ibuprofen. AIM: To assess if there are clinical characteristics effective as predictive factors for spontaneous closure of the ductus arteriosus, development of patent ductus arteriosus (PDA) and ibuprofen-resistant PDA. METHODS: A cohort of inborn infants less than 28 weeks of gestation were prospectively studied. We distinguished infants who had spontaneous closure of ductus arteriosus, who developed PDA and who developed ibuprofen-resistant PDA. RESULTS: We studied 34 infants. Eight infants (24%) had spontaneous closure of PDA, 17 infants (50%) had a closure of PDA following the first ibuprofen course, while 9 infants (26%) failed to respond to the first ibuprofen course. Infants born at 23-25 weeks of gestation were found to have lower likelihood of PDA spontaneous closure, and higher risk of developing PDA refractory to ibuprofen therapy. Sepsis was found to increase significantly the risk of ibuprofen failure in closing PDA. CONCLUSION: An important percentage of extremely preterm infants exhibited spontaneous closure of PDA. Among clinical characteristics lowest gestational ages predict PDA and ibuprofen-resistant PDA, while sepsis predicts only ibuprofen-resistant PDA.     

The fate of ductus arteriosus in infants at 23–27 weeks of gestation: from spontaneous closure to ibuprofen resistance

Background: Some extremely preterm infants experience spontaneous closure of the ductus arteriosus. On the other side, a high percentage (22–30%) of preterm infants born at the lower gestational age fail to respond to a single course of ibuprofen.
Aim: To assess if there are clinical characteristics effective as predictive factors for spontaneous closure of the ductus arteriosus, development of patent ductus arteriosus (PDA) and ibuprofen-resistant PDA.
Methods: A cohort of inborn infants less than 28 weeks of gestation were prospectively studied. We distinguished infants who had spontaneous closure of ductus arteriosus, who developed PDA and who developed ibuprofen-resistant PDA.
Results: We studied 34 infants. Eight infants (24%) had spontaneous closure of PDA, 17 infants (50%) had a closure of PDA following the first ibuprofen course, while 9 infants (26%) failed to respond to the first ibuprofen course. Infants born at 23–25 weeks of gestation were found to have lower likelihood of PDA spontaneous closure, and higher risk of developing PDA refractory to ibuprofen therapy. Sepsis was found to increase significantly the risk of ibuprofen failure in closing PDA.
Conclusion: An important percentage of extremely preterm infants exhibited spontaneous closure of PDA. Among clinical characteristics lowest gestational ages predict PDA and ibuprofen-resistant PDA, while sepsis predicts only ibuprofen-resistant PDA.     

N-terminal-pro-brain natriuretic peptide: a guide for early targeted indomethacin therapy for patent ductus arteriosus in preterm Infants

Aim: To determine whether N‐terminal‐pro‐brain natriuretic peptide (NT‐proBNP) level could be an effective guide for early targeted indomethacin therapy for patent ductus arteriosus (PDA) in preterm infants. Methods: An interventional study involved preterm infants, born at <33 weeks of gestation, who had plasma NT‐proBNP levels obtained at day 2 of life. Indomethacin therapy was given if plasma NT‐proBNP level was ≥10 180 pg/mL, the cut‐off for predicting hemodynamic significant PDA (hsPDA). Echocardiograms were performed within 6 h at the time of plasma NT‐proBNP collection and again at day 7, or whenever clinical hsPDA was suspected. Primary outcomes were the incidence of later hsPDA and unnecessary exposure rate to indomethacin. Results: Fifty infants were enrolled. On day 2, 19 (38%) infants had plasma NT‐proBNP above the cut‐off and received indomethacin therapy; none of them developed later hsPDA, while 1 of 31 infants with NT‐proBNP below the cut‐off level developed clinical hsPDA. Unnecessary exposure to indomethacin occurred in two infants (11%). Overall, no enrolled infants had either reopening of ductus or PDA ligation. Conclusion: Using NT‐proBNP level on day 2 as a guide for early targeted indomethacin therapy reduced later onset of hsPDA and the number of unnecessary exposures to indomethacin.     

Long-term variability of heart rate increases with successful closure of patent ductus arteriosus in preterm infants.

Long-term variability (LTV) of heart rate was calculated continuously by a microprocessor in 25 preterm infants undergoing indomethacin treatment for closure of patent ductus arteriosus (PDA), in 24 preterm infants without signs of PDA, and in 10 neonates treated with prostaglandin E1 for cyanotic heart malformation. In infants with patent ductus arteriosus, LTV was lower than in controls. Following indomethacin, LTV increased most markedly (from 1.5 to 3.2; p less than 0.01) in infants with improved ventilation. The increase was less marked (from 1.8 to 2.5; p less than 0.05) in infants whose degree of respiratory failure did not change. LTV remained largely unchanged in infants who deteriorated. In 9 out of the 10 neonates treated with prostaglandin E1, LTV increased. We conclude that LTV corresponds to brain stem oxygenation and may be a useful tool to monitor treatment of PDA.     

Different approaches for patent ductus arteriosus in premature infants using acetaminophen

Background Acetaminophen use for pharmacological treatment of hemodynamically significant patent ductus arteriosus(hsPDA)in preterm infants is becoming more pop...